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Volume 12 (1)
Volume 12, Issue 1, 1992 
J Contin Educ Health Prof 1992; 12(1):39-48
MEDICINE
Penny A. Jennett, PhD R. Wayne Elford, MD Russell J. Sawa, MD Stacy E. Smith, BSc A b s t r a c t Recent publications emphasize that factors associated with "practical" knowledge, clinical decisionmaking, and actions behind decisions in the delivery of office care are complex and go much beyond textbook knowledge. This study examines the factors that influence decisionmaking relating to the office care of males who are identified at high risk for coronary artery disease as determined by a Framingham algorithm. Twenty family physicians were interviewed regarding their care of 47 high-risk male patients between the ages of 35 and 60 using a case-stimulated recall approach. The practice, social, political, patient, and physician factors felt to inhibit and enhance health promotion in the office are reported. The importance of family involvement and a support system, and the impact of specific patient characteristics and needs on physicians promoting lifestyle change are highlighted. Strategies designed to guide practitioners' behaviors in decisionmaking must take the complex interaction of the personal, professional, and social "cultures" of practitioners, patient, and health care environments into consideration when new approaches to care, such as preventive care, are introduced. Without attention to these issues, CME focused primarily on physician knowledge, skills, and values may be somewhat limited in its ability to enhance practice change and optimal patient health. Keywords: Practice culture; practice context; office practice; family physician; health promotion |
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